Medicaid. Is it being abused?

[SWFlorida]

Medicaid was a great idea when first introduced to assure that even the very poor could get quality health care. I just wonder when I see someone drive up in a newer car come up to the triage desk in designer clothes and lots of gold jewelry and they are on medicaid. I know of many who are the working middle class who are struggling to pay their own insurance premiums. Why do so many folks get a free ride? Or am I missing something here?

[grannynurse FNP student]

Yes, please check your state's website *first* before you attempt to deny someone candy and soda because in my state and many others these items *ARE* allowed to be purchased with an EBT card and, therefore, they are not breaking the law.

It's so sad that a woman can be standing in line with her children buying a basket full of healthy food and someone would actually call a manager because she tries to buy her children a piece of candy or even a diet soda.

You are assuming that one, she had a cart full of healthy foods and two, I called the manager over while she was waiting to check out. Suggest you read my statement again. I approached the store manager. I mentioned nothing about keeping the mother waiting. And he spoke to his employee about her error in allowing the purchase. You made some assumptions. And in the state she was making the purchases in, candy and soda are not allowed. They may be in your state. And I really don't know what her other purchases were. I was only concerned about her candy purchase for her overweight child.

Grannynurse

[LydiaNN]

How about the young teenage girls who end up pregnant. Its almost an automatic qualification for full medicaid insurance, housing and food stamps. This can go on for generations.

Perhaps the government should tax those who have children out of wedlock as a burden to society. This may encourage teens to practice birth control. Those who are able to care for their children could receive a tax break if they show they have proper insurance, a home, and a full time job.

Is the system geared for the achievers or the irresponsible?

Uh... why would they concern themselves with tax breaks if, as you claim, they are "automatically" able to get all life's trappings for free. Assuming that this were the case (which it isn't, at least where I live, as the list for subsidized housing is years long), it isn't like they're paying taxes in the first place.

[grannynurse FNP student]

I followed the discussion about medicaid in the States.

In my country medicaid is mandatory for everybody. Each month every person (adult or child)pays a fee for medical insurance. When there is need to see the M.D., 10 % of the bill has to be paid, the remaining money is taken over by the insurance. The same procedure applies to hospital bills. Dental bills have to be paid fully.

If someone gets social wellfare, the city pays the monthly fee.

Now my question: Would a system like this be something that would work in the States?

Sorrento

Here in the U.S., Medicaid is funded by both each individual state and the federal government. Each state has the right to decide what services they wish to cover, if they wish to charge a co-payment, the number and type of medications, etc. For this reason, we have fifty different versions of Medicaid based on what fifty different states decided. Dental coverage again varies from state to state. In Florida, adults are covered only for complete extractions and dentures. No fillings, no crowns, no bridges or partials. In NYS they have a more liberal take on dental coverage. If an individual receives Medicare (a federal adult program) and Medicaid, the state pays the Medicare premium. So, unless you could get our President and Congress and all fifty states to agree on a federal funded and administrated program, no it is not possible.

Grannynurse:balloons:

[AtlantaRN, RN]

i had a girl come through the er, head to toe tommy hilfiger...asked if the doc could write her prescription for darvocet (she had totaled her new car), to her 9month old

[grannynurse FNP student]

i had a girl come through the er, head to toe tommy hilfiger...asked if the doc could write her prescription for darvocet (she had totaled her new car), to her 9month old

And as a professional, I hope that you and the physician taught her the inappropriateness of her request.

Grannynurse:balloons:

[ERnights]

I again feel the need to respond. This thread was initially started in the ED forum for us to discuss what we percieved as potential abuses. I think most experienced ED nurses here would have something to share regarding this subject. What I find very distracting is the lecture that is being given after every post made to address the prior poster's comments with facts, etc.

I dont understand why some writers feel the need to attempt to educate or whatever is the objective here. I personally am not changing my mind on my now perceptions. You may have had me listening when I was a brand new nurse 17 years ago and was still a democrat. I felt I wanted to help the world. Well now, I feel the world needs to try to help themselves a bit also.

I also want to say to Irish nurse that I thought she handled the nicoderm gum rx request very well. I'm sorry to disagree with the crowd. Smoking is an addiction alright, but it's a choice people make to pick it up. I'm sick of coddling people. There is nothing wrong with a little tough love. That pt was not shamed. You all don't think she is smart enough to realize what irishnurse said is true. Do we have to hide the rough truth from her. No. If no one ever told her before, then she should feel educated that now she knows that cigarettes cost money.

People need to own up for their actions in society, people need to pay for what they take, they need to respect rules, etc. So while we give people treatment for their nonurgent complaints we do not have to cab voucher them up the street when the rest of the time they take the bus. Incidentally, over the past few years, 3 Boston area hospitals have closed 2nd lack of funds. I'm not saying that cab vouchers and rx for tylenol did this, but it certainly didn't help.

Take care.

[LydiaNN]

My problem with irishnurse's nicoderm story was that it kept changing. In its initial version, it did sound as if she shamed the patient. Bits and pieces kept being rearranged, till in the end, I really didn't know what to make of the story.

[Multicollinearity, BSN, RN]

Well, after reading every single post in this thread I am quite frustrated. In fact I think I am returning to my previous 'motto' regarding any internet forum which is 'no debate topics, only info topics'. Does anyone in a debate really leave a part of his/her psyche open to change? Or do we just argue our position, hit enter, then grin at the firmness of opinion and reasoning we have displayed? I don't know.

I do know that nothing is black and white. (Hence my screen name Multicollinarity, although I spelled it wrong, it's Multicollinearity, meaning so many variables contributing to a result that are so interelated they cannot be exactly stratified.)

Fact is, the emergency departments in the US are in crisis. It's the only guaranteed access to health care. Add to that the nursing shortage and it's crazy.

I do know that there is some abuse of the ED with patients, particularly Medicaid patients because they have no copay. But when people live below the poverty level they literally don't have the $$'s for a copay. Here in Arizona we have managed care for our Medicaid, we call it AHCCCS. When I worked in an ER years ago, after the patient was triaged we could not treat the patient (unless a trauma, or life-threatening) unless the PCP called to authorize the ER visit. I don't know if they still require that. I would have sympathy for PCPs getting rung up all the time and night for permission to go to the ER.

I also know from a friend who has to be on Medicaid during nursing school that it is not uncommon for her to be treated in a substandard fashion because she's on Medicaid. She is impeccable in her conduct, it's the Medicaid label. So it's not a black and white issue, i.e. all Medicaid patients are horrible, or all ER nurses treat Medicaid patients horribly. It's much more complex than that. And stereotypes do come from somewhere. There's a kernal of truth in stereotypes of some Medicaid patients.

I am also mindful as a student that the stress ER nurses endure is extreme and can render some of these discussions academic.

That said, I challenge anyone to show the nicotine patch scenerio to any nursing professor and be told it's ethical. It's absolutely not ok because it's a political act, instead of following standards of care and providing medical treatment.

In the end however, if this is the worst thing a nurse does in the ER then ok. I say this because we will all make mistakes and the stress of ER is horrendous. Better mistakes be minor ethical ones than major ones causing morbidity.

I do maintain that a significant portion of the anger displayed in this thread is NOT anger directly towards Medicaid patients, but rather frustration at our own cost of health care.

[LeahJet, ASN, RN]

Personal opinion may have been the starting point but when it is used as fact, I and others have to take issue with those personal opinions. And you have ignored my questions. Do you think that I just make up my take on the issues? If you and others do, you are wrong. I have study our health care system and those of other countries since 1974. And studied them formally, in grad school and informally by keeping up on the most current research. I have also had practical experience in dealing with fraud and abuse, in the Medicaid system, kept in touch with some of my former contacts who also conduct research into health care systems and Medicaid and Medicare, plus experience in hospital administration, health care management and with the insurance industry. And I keep in touch with friends in those areas. So, while I may express my personal opinion, unlike some here, mine is steeped in not only personal experience but research, conducted by valid researchers. One may post what they wish regarding their personal opinion but when they post it as fact taking place all over this country, I and others will call them on it. It is always better to back up an opinion by presenting hard data and facts, something personal opinion sorely lacks.

Grannynurse

I think that just about anyone here that half way keeps up on this BB knows about your extensive expertise in the research, administration, and investigative aspects of nursing and healthcare in the 70's and 80's. You have accomplished a lot and you are proud...and rightfully so.

Just as most of us aren't privy to all the facts and research that you have been exposed to for so many years, I think it may be fair to say that maybe you may have limited exposure in "the trenches". As someone else pointed out earlier.... SO many ER (and other) nurses can't all be wrong. While we may not have the facts, figures, and graphs sitting in front of us on a desk, I am pretty sure we have a grasp on what is going on out there. Just like the age old gripe that nurses have with administration.....

It looks good on paper, but it ain't workin'.

[grannynurse FNP student]

I think that just about anyone here that half way keeps up on this BB knows about your extensive expertise in the research, administration, and investigative aspects of nursing and healthcare in the 70's and 80's. You have accomplished a lot and you are proud...and rightfully so.

Just as most of us aren't privy to all the facts and research that you have been exposed to for so many years, I think it may be fair to say that maybe you may have limited exposure in "the trenches". As someone else pointed out earlier.... SO many ER (and other) nurses can't all be wrong. While we may not have the facts, figures, and graphs sitting in front of us on a desk, I am pretty sure we have a grasp on what is going on out there. Just like the age old gripe that nurses have with administration.....

It looks good on paper, but it ain't workin'.

Hate to tell you this but I worked in the trenches just like everyone else did, even when I was in administration. I worked staff relief at P & S, NYC. And in the 80s, I also worked in staff relief during season, here in Florida. So please don't make the comment about administration. And one can limit ones education and the journals one reads if one wants. I've had a very busy and active life, tied up with work education and raising my daughter. I read when ever I can find the time, on the bus, in bed, eating a meal, waiting in a physician's office, waiting in a client's employer's office, by the pool, at the beach,even in the bathroom. My daughter has commented that I will die with either a book or journal in my hand. I sure hope so.

Grannynurse

[grannynurse FNP student]

I think that just about anyone here that half way keeps up on this BB knows about your extensive expertise in the research, administration, and investigative aspects of nursing and healthcare in the 70's and 80's. You have accomplished a lot and you are proud...and rightfully so.

Just as most of us aren't privy to all the facts and research that you have been exposed to for so many years, I think it may be fair to say that maybe you may have limited exposure in "the trenches". As someone else pointed out earlier.... SO many ER (and other) nurses can't all be wrong. While we may not have the facts, figures, and graphs sitting in front of us on a desk, I am pretty sure we have a grasp on what is going on out there. Just like the age old gripe that nurses have with administration.....

It looks good on paper, but it ain't workin'.

By the way (and this is not meant as a put down) but you failed to mention I have worked in more then 15 years. And that my experience is hopelessly outdated, unless you count all my ER visits, conversations with nursing staff and my own personal obersvations. But then again, some think they count for nothing because they have been observed from the patient's prespective. And we all know how distorted patients views are, just look at their unreasonable ER demands.

Night

Grannynurse

[LeahJet, ASN, RN]

Hate to tell you this but I worked in the trenches just like everyone else did, even when I was in administration. I worked staff relief at P & S, NYC. And in the 80s, I also worked in staff relief during season, here in Florida. So please don't make the comment about administration. And one can limit ones education and the journals one reads if one wants. I've had a very busy and active life, tied up with work education and raising my daughter. I read when ever I can find the time, on the bus, in bed, eating a meal, waiting in a physician's office, waiting in a client's employer's office, by the pool, at the beach,even in the bathroom. My daughter has commented that I will die with either a book or journal in my hand. I sure hope so.

Grannynurse

First and foremost, I can and will make comments about administration. Anyone that has worked in the past 10 years knows how administration can be. Do you not take into account any of the posters here and cases of injust treatment by the powers that be? Again, do we all have an incorrect comprehension of what we see every day? We do not get all of our info from journals....we live it. Which, by the way, I tend to be a pretty well read person myself. Maybe "one" can have an all or none attitude...assuming that one does not read and keep well informed or educated because one actually works at bedside. For one so openminded and enlightened, there seems to be a lot of assuming and judging going on. But wait, I'm not on Medicaid....so I am not exempt from judgement.

As a previous poster stated....opinions will not change. I have read with an open mind and I truly do see points on both sides. Has my opinion changed? No.

Again, it never ceases to amaze me how some of the most liberal can pass judgement themselves and it is viewed as acceptable as long it is beneficial to their own cause.